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I have completed this client in-take form to the best of my knowledge and that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. I also understand that La Vita Bella Day Spa LLC is not res- responsible for any problems that may occur during any treatment if I am using any topical or oral, prescribed or over the counter medications.
La Vita Bella Day Spa5416 Roberts StreetShawnee, KS
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